Abstract
Background: Neuraxial opioids improve labour analgesia and analgesia after caesarean section (CS) and hysterectomy. Undesirable side effects and difficulties in arranging postoperative monitoring might influence the use of these opioids. The aim of the present survey was to assess the use of intrathecal and epidural morphine in gynaecology and obstetrics in Sweden. Methods: A questionnaire was sent to all anaesthetic obstetric units in Sweden concerning the use and postoperative monitoring of morphine, sufentanil and fentanyl in spinal/epidural anaesthesia. Results: A total of 32 of 47 (68%) units responded representing 83% of annual CS in Sweden. In CS spinal anaesthesia, 20/32 units use intrathecal morphine, the most common dose of which was 100 μg (17/21). Intrathecal fentanyl (10-20 μg) was used by 21 units and sufentanil (2.5 -10 μg) by 9/32 of the responding units. In CS epidural anaesthesia, epidural fentanyl (50-100 μg) or sufentanil (5-25 μg) were commonly used (25/32), and 12/32 clinics used epidural morphine, the majority of units used a 2 mg dose. Intrathecal morphine for hysterectomy was used by 20/30 units, with 200 μg as the most common dose (9/32). Postoperative monitoring was organized in adherence to the National Guidelines; the patient is monitored postoperative care or an obstetrical ward over 2-6 hours and up-to 12 hours in an ordinary surgical ward. Risk of respiratory depression/difficult to monitor was a reason for not using intrathecal opioids. Conclusions: Neuraxial morphine is used widely in Sweden in CS and hysterectomy, but is still restricted in some units because of the concern for respiratory depression and difficulties in monitoring.
Highlights
Intrathecal and epidural morphine improve postoperative analgesia after caesarean section (CS) and hysterectomy and during intrathecal labour analgesia[1,2,3]
We identified the anaesthesiologist in charge of the obstetric and gynaecological anaesthesia for each unit by address lists used by Swedish Society of Obstetric Anaesthesia and Intensive Care (SFOAI), and if these were not present the hospital was phoned to get hold of the anaesthesiologist in charge
Sufentanil is the most common opioid added in labour anaesthesia in Sweden, which was reported in a national obstetric anaesthesia meeting from a survey in 2009 (Data on file)
Summary
Intrathecal and epidural morphine improve postoperative analgesia after caesarean section (CS) and hysterectomy and during intrathecal labour analgesia[1,2,3]. In 1981, the Swedish Society of Anaesthetists conducted a nationwide survey of experience with intrathecal and extradural opiates[4] They found intrathecal morphine was administered in total to only 90–150 patients in 10 of 93 responding units, and ventilatory depression requiring treatment with naloxone was needed in six of these patients. Methods: A questionnaire was sent to all anaesthetic obstetric units in Sweden concerning the use and postoperative monitoring of morphine, sufentanil and fentanyl in spinal/epidural anaesthesia. Conclusions: Neuraxial morphine is used widely in Sweden in CS and hysterectomy, but is still restricted in some units because of the concern for respiratory depression and difficulties in monitoring
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